Purification of household water using a novel mixture reduces diarrhoeal disease in Matlab, Bangladesh

In Bangladesh, one of the main causes of waterborne diseases is related to the use of contaminated surface water. This pilot study was conducted to determine the acceptability and effectiveness of a recently developed surface water purifying mixture to prevent diarrhoeal diseases in a rural community in Bangladesh. The mixture, using a combination of alum potash, bleaching powder and lime, is added to 15 l of surface water and mixed; the water becomes suitable for drinking after 30 min. A total of 420 households from 15 villages were provided with the mixture and were taught how to use it. Episodes of diarrhoeal disease from study families were determined from hospital records of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in Matlab and were compared with diarrhoea episodes among 1613 control families who were not provided with the mixture. A total of 83 diarrhoeal patients were treated at Matlab Hospital from 1613 control families, but only one patient was treated for diarrhoea from among the intervention families. Among the intervention families, 73 families decided to shift from using tube well water to surface water using the mixture. The mixture could be used as a cheaper, easier and simpler point-of-use water treatment strategy in Bangladesh.

Effect of water management, tillage options and phosphorus status on arsenic uptake in rice

High arsenic (As) concentrations in soil may lead to elevated concentrations of arsenic in agricultural products. Field experiments were conducted to examine the effects of water management (WM) and Phosphorus (P) rates on As uptake, rice growth, yield and yield attributes of winter (boro) and monsoon (aman) rice in an As contaminated soil-water at Gobindagonj, Gaibandha, Bangladesh in 2004 and 2005. Significantly, the highest average grain yields (6.88±0.07 t ha(-1) in boro 6.38±0.06 t ha(-1) in aman) were recorded in permanent raised bed (PRB; aerobic WM: Eh=+360 mV) plus 100% P amendment. There was a 12% yield increase over conventional till on flat (CTF; anaerobic WM: Eh=-56 mV) at the same P level. In boro, the As content in grain and As content in straw were about 3 and 6 times higher in CTF compared to PRB, respectively. The highest total As content (0.646±0.01 ppm in grain and 10.93±0.19 ppm in straw) was recorded under CTF, and the lowest total As content (0.247±0.01 and 1.554±0.09 ppm in grain and straw, respectively) was recorded under PRB (aerobic WM). The results suggest that grain and straw As are closely associated in boro rice. The furrow irrigation approach of the PRB treatments consistently reduced irrigation input by 29-31% for boro and 27-30% for aman rice relative to CTF treatments in 2004 and 2005, respectively, thus reducing the amount of As added to the soil from the As-contaminated irrigation water. Yearly, 30% less As was deposited to the soil compared to CTF system through irrigation water during boro season. High As concentrations in grain and straw in rice grown using CTF in the farmers' field, and the fact that using PRB reduced grain As concentrations to value less than half of the proposed food hygiene standard.

Characterization of spinal cord lesion in patients attending a specialized rehabilitation center in Bangladesh

STUDY DESIGN

This study was designed as a cross-sectional study.

OBJECTIVES

The objective of this study was to find out the clinical types and sociodemographic characteristics of patients with spinal cord lesion (SCL).

SETTING

Centre for the Rehabilitation of the Paralysed (CRP).

METHODS

Data were collected by face-to-face interview, with a structured interview schedule from admitted patients. Descriptive measures and χ(2)-test were applied for data analysis.

RESULTS

Of 107 patients, majority (20%) belonged to age group of 25-29 years (mean 31±12.2 years). About 83% were males; 65% married and 54% illiterate. Agricultural and other day laborers constituted the major occupation groups with mean monthly family income of US $60 (±$53). About 92% came from rural area and 84% belonged to nuclear family. About one-third of the patients were referred by the medical college hospitals. About 65% of the patients were admitted at 1-29 days of lesion with longest duration of 3 years. Patients were mostly (93%) traumatic. Fifty-four percent had paraplegia and most common skeletal level segment was cervical (44%). About 43% had pressure sores at admission. Eighty-nine percent needed management for bladder function through the use of catheter. Age, sex and occupation were associated with type of paralysis, skeletal level of injury and neurological condition; physical status, causes of lesion, type of injury and skeletal level of injury; and skeletal level of injury, respectively (P<0.05).

CONCLUSION

Major cause of SCL was traumatic. Available treatment facilities were inadequate and needed improvement through government and private initiatives.

Respiratory bacterial flora from healthy as well as respiratory symptoms' subjects

Respiratory system is the primary settlement place of opportunistic organisms and considered as chief carrier of common respiratory pathogens. The aim of the study was to know the opportunistic organisms present in the healthy subjects as well as subjects that were suffering from respiratory symptoms. The organisms were identified as per standard bacteriological protocol and pathogenicity tests of the identified organisms were performed in mouse model. Antibiotic sensitivity of the identified organisms was performed. The bacterial flora present in the throat swab of apparently healthy as well as subjects suffering from respiratory symptoms were: Staphylococcus spp. (39.44%) of which Coagulase positive Staphylococcus (21.13%) and Coagulase negative Staphylococcus (18.31%), Klebsiella spp. (19.72%), Pseudomonas spp. (15.49%), Proteus spp. (4.23%), E. coli (9.86%) and Bacillus spp. (11.27%). Among the isolates Staphylococcus, Klebsiella and Pseudomonas were the predominant species. Percentages of identified bacteria were higher in respiratory symptoms exhibiting individuals (53.52%) than apparently healthy individuals (46.48%). All coagulase positive Staphylococcus, Klebsiella spp. and Pseudomonas spp. isolated from respiratory symptoms' subjects were found to be pathogenic. The isolated bacteria were resistant to amoxicillin and ampicillin but sensitive to ciprofloxacin and norfloxacin. Isolated Pseudomonas spp. showed multidrugs resistant properties. The study provided information about the pathogenic organisms' present respiratory systems of apparently healthy as well as subjects suffering from respiratory symptoms. The pathogenic natures of the isolated organisms were determined to make aware of scientists as well as clinicians. Antibiotics sensitivity assays would provide information to the clinicians for the selection of appropriate antibiotics to treat their patients.

Recurrent synovial chondromatosis of the foot

Synovial chondromatosis rarely occurs in the foot. We have diagnosed such a case in National Institute of Cancer Research and Hospital, Mohakhali, Dhaka. The patient came to us with a swelling in the dorsum of left foot. He had a history of operation but one year later swelling reappeared in the same place. Fine Needle Aspiration Cytology (FNAC) of the swelling revealed few atypical cells and diagnosed as a case of malignant neoplasm. Later on surgical intervention was done in the form of wide excision and final histopathology report came as Synovial chondromatosis. No special treatment was given other than periodical follow up. The patient has been responding well. There was no clinical or radiographic evidence of recurrence.

Effect of hesperidin in vitro on root dentine collagen and demineralization

OBJECTIVES

Caries progress might be controlled when collagen matrix could be preserved after demineralization. The aim of this pH cycling study was to investigate the effect of hesperidin, a citrus flavonoid antioxidant, on dentine collagen and remineralization in dentine lesion, and compared with that of chlorhexidine.

METHODS

The pH cycling was employed on bovine root dentine by demineralization for 14 h, incubation in testing solutions (hesperidin or chlorhexidine) for 2 h and remineralization with bacteria-derived collagenase for 8 h, for 8 days. Calcium release was measured by means of an atomic absorption spectrophotometer, and degraded collagen matrix by collagenase was investigated by assaying hydroxyproline. The lesion depth and mineral loss was evaluated by means of transverse microradiography.

RESULTS

The effect of testing solutions had a significant difference on the results of chemical analyses (p<0.0115 for calcium release; p<0.0008 for degradated collagen). The lesion depth and mineral loss were reduced in the lesions where were incubated with hesperidin and chlorhexidine. The remineralization in deep lesions was found when the matrix was incubated in hesperidin, whilst no mineral uptake in deep lesion when incubated in chlorhexidine.

CONCLUSION

Hesperidin preserved collagen and inhibited demineralization, and enhanced remineralization even under the fluoride-free condition.

Prevalences of Giardia lamblia and Cryptosporidium parvum infection in adults presenting with chronic diarrhoea

Giardia lamblia and Cryptosporidium parvum are both waterborne pathogens associated with diarrhoea in developing countries. In a recent study based at the Aga Khan University in Karachi, 334 adults aged 16-83 years (178 patients with chronic diarrhoea and 156 diarrhoea-free volunteers who acted as controls) were checked for infection with these parasites, using stool microscopy and/or PCR. Overall, 21 (6.3%) and 29 (8.7%) of the subjects were found positive for G. lamblia by microscopy and PCR, respectively, while the corresponding values for C. parvum were 13 (3.9%) and 14 (4.2%). Although, compared with the diarrhoea-free controls, the patients with diarrhoea were not significantly more likely to be found infected with Giardia, either by microscopy [15 (8.4%) v. six (3.8%); P=0.085] or PCR [19 (10.7%) v. 10 (6.4%); P=0.167], they were significantly more likely to be found infected with C. parvum, both by microscopy [11 (6.2%) v. two (1.3%); P=0.024] and by PCR [12 (6.7%) v. two (1.3%); P=0.014]. The 19 patients found PCR-positive for Giardia comprised 10 (67%) of the 15 found smear-positive for the same parasite but only nine (5%) of the 163 found smear-negative (k=0.545; P<0.001). Similarly, the 12 patients found PCR-positive for Cryptosporidium comprised all 11 (100%) patients found smear-positive for the same parasite but only one (0.6%) of the 167 found smear-negative (k=0.954; P<0.001). Although C. parvum was associated with chronic diarrhoea in the present study, the carriage of G. lamblia often appeared asymptomatic.

Value of dysmorphic red cells and G1 cells by phase contrast microscopy in the diagnosis of glomerular diseases

The morphology of red cells by phase-contrast microscopy (PCM) is a useful diagnostic marker for glomerular haematuria. This study evaluated the value of urinary dysmorphic red cells and G1 cells (special type of dysmorphic red cell) count by PCM providing a simple, cost effective and low risk technique in the diagnosis of glomerular diseases. Urine samples of 120 patients with haematuria and proteinuria were examined and the percentage of dysmorphic red cells and G1 cells were calculated. Cases were divided into two groups; group I (>20% dysmorphic red cells- glomerular group) and group II (≤20% dysmorphic red cells as non glomerular group). Renal histopathology was used as the gold standard method for the diagnosis of glomerulonephritis. Results from PCM showed a sensitivity of 92.7%, specificity 100% by the detection of dysmorphic red cell while by the detection of G1 cells, a sensitivity of 97.6% and specificity 100% were observed. The percentage of G1 cells is superior to counting dysmorphic red cells. The high sensitivity of phase contrast microscopy confirms its usefulness for the detection of dysmorphic red cells and G1 cells that can guide clinicians in the identification of the site of haematuria using non invasive tests.

POEMS Syndrome

A 49 years old male patient admitted with 2 years history of lower extremity symmetrical sensorimotor polyneuropathy, sclerodermic skin change, erectile dysfunction, hepatosplenomegaly and monoclonal gammopathy. The clinical evaluation met the criteria for the diagnosis of (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes) POEMS syndrome. The patient was treated with corticosteroid and melphelan and responded well. We present a case different from the other cases with severe unusual burning sensation all over the body, which was his sole complaint and with this complaint he visited lot of doctors including psychiatrist.

Postoperatve pain relief in children after subumbilical surgeries-a comparison between caudal bupivacaine and bupivacaine-clonidine

In a randomised case control study in children undergoing elective subumbilical surgery, we have assessed the clinical value of bupivacaine and bupivacaine-clonidine mixture for caudal analgesia. Sixty children aged 2-10 years, were allocated randomly to two equal groups (n=30) to receive 0.25% bupivacaine 1ml/kg (Group I) and 0.25% bupivacaine 1ml/kg with clonidine 2μg/kg (Group II). The baseline haemodynamic parameters, heart rate and blood pressure were recorded. Intraoperatively children in both groups maintained haemodynamic stability and required less amount of muscle relaxant. Duration of analgesia in minutes was assessed by the time interval between the caudal extradural injection and the first analgesic demand by the patient. It was significantly longer (p=0.000) in Group II (712 ± 15.30 minutes) as compared with Group I (246 ± 8.74 minutes). Group II required significantly less supplementary analgesia after operation. There was no significant difference in the incidence of side effects between the two groups. Group I received more doses of diclofenac suppository in first 24 postoperative hours. We conclude that, when added to bupivacaine, clonidine improves the duration of caudal analgesia in children undergoing subumbilical surgery.

Anthropometric measurements of the arm span and their correlation with the stature of bangladeshi adult muslim females

Anthropometry is the science that deals with the measurement of size, weight and proportion of the human body. Stature is natural heights of a person in an upright position. This can be estimated from arm span length. In the last 50 years of the 20th century various mass disasters such as different powerful storm, flood, plane crash, train accident was increased. Very recently in Chittagong and southern Bangladesh many people were killed through land slides and Seder. As so many disasters were occurring it is possible to identify a missing person if a part of his or her body is available. The arm span lengths can be used as a basis for estimating age-related loss in stature and as an alternative measure to stature. The study was done for the estimation of stature from the arm span on one hundred and fifty Bangladeshi adult Muslim females. Subject was collected from Bangabandhu Sheikh Mujib Medical University, Dhaka and some urban region of Dhaka, Bangladesh. The present study showed significant (p<0.001) positive correlation between the stature and the arm span.

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.

Early renal damage assessed by the SLICC/ACR damage index is predictor of severe outcome in lupus patients in Pakistan

We investigated patients with systemic lupus erythematosus with the objective of assessing whether early damage accrued in systemic lupus erythematosus as measured by the SLICC/ ACR Damage Index predicts mortality in lupus patients that have been followed prospectively in a single center. Patients with systemic lupus erythematosus from Aga Khan University hospital presenting between 1992 and 2007 were included. This enabled all patients to be potentially followed for at least 10 years. Yearly SLICC/ACR Damage Index scores were determined for each patient. Early damage was defined as a score ≥1, and no damage as a score of 0 at the initial assessment. Kaplan—Meier and Log rank tests were used to compare the survival experience between those with and without damage, with all patients being assessed at 10 years. In this inception cohort 198 patients were identified and were followed for 10 years. Of these, 47 (23.7%) patients had a SLICC/ACR Damage Index score of 0 (no damage) while 151 patients (76.3%) had at least one SLICC/ACR Damage Index item scored (early damage). Mean renal damage score at 1, 5 and 10 years was 0.16, 0.34 and 0.67, respectively. Of lupus patients who exhibited renal damage at their first SLICC/ACR Damage Index assessment, 31% died within 10 years of their illness as compared with only 13% who had no early renal damage (p < 0.003). Mean renal damage score at 1 year after diagnosis was a significant predictor of death within 10 years of diagnosis (p < 0.002). Lupus (2010) 19, 1573—1578.

Health care risk factors among women and personal behaviours among men explain the high prevalence of hepatitis C virus infection in Karachi, Pakistan

To estimate the prevalence and identify factors associated with hepatitis C virus (HCV) infection among men and women in Karachi, Pakistan. We conducted a cross-sectional study of adult men and women in a peri-urban community of Karachi (Jam Kandah). Households were selected through systematic sampling from within all villages in the study area. All available adults within each household were interviewed about potential HCV risk factors. A blood specimen was collected to test for anti-HCV antibodies by enzyme immunoassay. We used generalized estimating equations while accounting for correlation of responses within villages to identify the factors associated with HCV infection. Of 1997 participants, 476 (23.8%) were anti-HCV positive. Overall, HCV infection was significantly associated with increasing age, ethnicity, and having received > or =2 blood transfusions, > or =3 hospitalizations, dental treatment and >5 injections among women. Among women, > or =2 blood transfusions [adjusted odds ratio (aOR) = 2.32], >5 injections during the past 6 months (aORs = 1.47), dental treatment (aOR = 1.31) and increasing age(aOR = 1.49), while among men, extramarital sexual intercourse (aOR = 2.77), at least once a week shave from barber (aOR = 5.04), > or =3 hospitalizations (aOR = 2.50) and increasing age (aOR = 1.28) were associated with HCV infection. A very high prevalence of HCV was found in the study population. Among women, unsafe health care practices, while among men extramarital sex, shaving from a barber and hospitalizations were associated with HCV infection. Efforts are needed to improve the safety of medical procedures to reduce the transmission of HCV in Pakistan [Corrections made in Summary after initial online publication.].

Expression of a Rho guanine nucleotide exchange factor, Ect2, in the developing mouse pituitary

The pituitary gland is a highly mitotically active tissue after birth. Various cell types are known to undergo proliferation in the anterior pituitary. However, little is known about the mechanisms regulating mitotic activity in this tissue. When searching for genes specifically expressed in the pituitary gland among those that we previously screened in Drosophila, we found epithelial cell-transforming gene 2 (Ect2). Ect2 is a guanine nucleotide exchange factor for Rho GTPases, which is known to play an essential role in cytokinesis. Although there have been many cellular studies regarding the function of Ect2, the temporal and spatial expression patterns of Ect2 in vivo have not been determined. In the present study, we examined the postnatal developmental expression of Ect2 in the mouse pituitary. Enhanced Ect2 expression was detected in the mouse pituitary gland during the first 3 weeks after birth, which coincided well with the period of rapid pituitary expansion associated with increased growth rate. Immunostaining analysis showed that Ect2-expressing cells were distributed in the anterior and intermediate lobes, but not the posterior lobe, of the pituitary. These Ect2-expressing cells frequently incorporated the thymidine analogue, EdU (5-ethynyl-2'-deoxyuridine), indicating that these cells were mitotically active. Taken together, the results demonstrate the functional role of Ect2 in postnatal proliferating cells in the two lobes of the pituitary, thereby suggesting roles in developmental growth of the mammalian pituitary.

Intracellular calcium elevation induced by extracellular application of cyclic-ADP-ribose or oxytocin is temperature-sensitive in rodent NG108-15 neuronal cells with or without exogenous expression of human oxytocin receptors

ADP-ribosyl cyclase and/or CD38 are activated after oxytocin receptor stimulation in the hypothalamus and pituitary in adult mice, leading to facilitation of oxytocin secretion. Although cyclic adenosine 5'-diphosphoribose (cADPR) primarily acts as an intracellular second messenger, it has been suggested that extracellular cADPR stimulates intracellular ryanodine receptors after internalisation via the nucleotide-transporting capacity of CD38 in fibroblasts and astrocytes. However, little is known about whether extracellular cADPR activates neurones. To address this question, we used a model neuronal cell line, NG108-15 mouse neuroblastoma x rat glioma hybrid cells possessing CD38 but not oxytocin receptors, and measured cytosolic free calcium concentrations ([Ca(2+)](i)). Extracellular application of cADPR to NG108-15 cells elevated [Ca(2+)](i) at 35 degrees C. The elevation was significantly enhanced when measured at 40 degrees C. The cADPR and heat-induced [Ca(2+)](i) increase were blocked under extracellular Ca(2+)-free conditions and by 2-aminoethoxydiphenyl borate, an antagonist of melastatin-related transient receptor potential channel 2 (TRPM2) cation channels. Reverse transcriptation-polymerase chain reaction analyses indicated that TRPM2 channels were expressed in NG108-15 cells. Application of oxytocin elevated [Ca(2+)](i) in NG108-15 cells transformed to transiently express cloned human oxytocin receptors. The oxytocin-induced [Ca(2+)](i) response was also enhanced by heat. These results indicate that the extracellular application of cADPR, together with heat, activates cation influx downstream of oxytocin receptor signalling in NG108-15 neuronal cells, and suggest the possible involvement of TRPM2 channels in oxytocin release in the mammalian brain.